Exemplar 2.5: Leukemia

"Leukemia is a type of cancer that happens when the body produces white blood cells that don't help with the immune response, which is what they're supposed to do. Instead, these cells clone rapidly and leak into the bloodstream, where they replace the normal white blood cells."

"As the bad white blood cells fill the spongy stuff in some of your bones called your bone marrow, cells that produce other blood products get crowded out."

"Leukemias can be acute or chronic AND they can be lymphocytic or myeloid."

"Acute means they happen fast and progress fast, and chronic means they happen slowly and progress slowly. Additionally, lymphocytic means they happen in immature versions of a cell called 'lymphocytes', and myeloid means they involve cells called myeloid stem cells."

"There are also subtypes of both acute and chronic leukemia."

"Acute myeloid leukemia and chronic lymphocytic leukemia are the most common types of leukemia in children."

"This form of leukemia is characterized by uncontrolled division of cells called myeloblasts and enlargement of the bone marrow and spleen. It's quite uncommon for people under the age of 40 to get."

"This form of leukemia is characterized by abnormal division of all parts of the bone marrow, and it's associated with a chromosomal abnormality called the Philadelphia chromosome. It's very rarely seen in children."

"Most of the time, this leukemia results from a malformation in the Philadelphia chromosome. Most cases result from cancerous transformation of B-cells, causing them to reproduce quickly but not mature. This is the most common type in children."

"This type of leukemia is characterized by division and build-up of small, abnormal, mature lymphocytes, usually B-lymphocytes, in different parts of the body. It is rarely seen in children and adults under the age of 40."

"This form of leukemia is characterized by uncontrolled division of cells called myeloblasts and enlargement of the bone marrow and spleen. It's quite uncommon for people under the age of 40 to get."

"This form of leukemia is characterized by abnormal division of all parts of the bone marrow, and it's associated with a chromosomal abnormality called the Philadelphia chromosome. It's very rarely seen in children."

"Most of the time, this leukemia results from a malformation in the Philadelphia chromosome. Most cases result from cancerous transformation of B-cells, causing them to reproduce quickly but not mature. This is the most common type in children."

"This type of leukemia is characterized by division and build-up of small, abnormal, mature lymphocytes, usually B-lymphocytes, in different parts of the body. It is rarely seen in children and adults under the age of 40."

"This type of leukemia is characterized by division and build-up of small, abnormal, mature lymphocytes, usually B-lymphocytes, in different parts of the body. It is rarely seen in children and adults under the age of 40."

"Most of the time, this leukemia results from a malformation in the Philadelphia chromosome. Most cases result from cancerous transformation of B-cells, causing them to reproduce quickly but not mature. This is the most common type in children."

"This form of leukemia is characterized by abnormal division of all parts of the bone marrow, and it's associated with a chromosomal abnormality called the Philadelphia chromosome. It's very rarely seen in children."

"This form of leukemia is characterized by uncontrolled division of cells called myeloblasts and enlargement of the bone marrow and spleen. It's quite uncommon for people under the age of 40 to get."

"This form of leukemia is characterized by uncontrolled division of cells called myeloblasts and enlargement of the bone marrow and spleen. It's quite uncommon for people under the age of 40 to get."

"This form of leukemia is characterized by abnormal division of all parts of the bone marrow, and it's associated with a chromosomal abnormality called the Philadelphia chromosome. It's very rarely seen in children."

"Most of the time, this leukemia results from a malformation in the Philadelphia chromosome. Most cases result from cancerous transformation of B-cells, causing them to reproduce quickly but not mature. This is the most common type in children."

"This type of leukemia is characterized by division and build-up of small, abnormal, mature lymphocytes, usually B-lymphocytes, in different parts of the body. It is rarely seen in children and adults under the age of 40."

Fatigue and exercise intolerance r/t anemia

Bleeding

Lymphadenopathy and splenomegaly

Recurrent infections, pallor, edema, and thrombophlebitis

Fatigue, weakness, fever, and headaches caused by anemia.

Bone and joint pain caused by bone infarctions or subperiosteal infiltrates.

Abnormal bleeding and bruising due to thrombocytopenia.

Recurrent infection due to neutropenia.

Lymphadenopathy, splenomegaly, and hepatomegaly.

Vomiting, visual disturbances, and seizures.

Chronic

Accelerated

Acute

Chronic

Accelerated

Blast

Acute phase

Accelerated phase

Chronic phase

"ALL is the most common type of leukemia in children. It is often caused by a mutation called a translocation in a gene called the Philadelphia chromosome."

"Most cases are called by cancerous changes in white blood cells called B-cells. These cells don't function effectively enough to maintain immunity."

"Most cases are called by cancerous changes in white blood cells called T-cells. These cells don't function effectively enough to maintain immunity."

"The immature white blood cells, called lymphoblasts, build up in the bone marrow , lymph nodes, spleen, and circulating blood."

"Because the lymphoblasts divide so fast, the body doesn't produce normal blood cells; the lymph nodes and the liver enlarges; and the bones start to hurt."

Acute myeloid leukemia

Chronic myeloid leukemia

Acute lymphocytic leukemia

Chronic lymphocytic leukemia

A 5-year-old boy recently diagnosed with a disease causing immunodeficiency.

A 2-year-old girl diagnosed with Downs syndrome.

A 10-year-old girl who was exposed to radiation following the Fukushima Daiichi nuclear disaster in 2011.

An 8-year-old whose parents smoke.

A 15-year-old diagnosed with human papilloma virus.

A 12-year-old who underwent treatment for a brain tumor as a child.

A 50-year-old female who spent the last 34 years as a smoker.

A 65-year-old female who lived close to the blast site when the Chernobyl disaster happened.

A 5-year-old diagnosed with Kleinfelter syndrome.

A 30-year-old who underwent treatment for ALL as a child.

Implement transmission-based precautions.

Perform careful hand hygiene and make sure all visitors do the same.

Take vital signs every 4 hours and report manifestations of infection.

Provide oral hygiene after every meal.

Document manifestations of infection.

Take vital signs at the beginning and end of every shift to minimize contact with patient.

Fever, chills, and temperature spikes.

Chest pain, painful urination, and burning in vaginal or rectal area.

Coughing.

Purulent drainage.

Tachypnea, tachycardia, changes in PaO2, and hypotension.

Neutrophil level at 2,600/mm3

Administer morphine 0.2 mg/kg IV push q6 hr.

TPR q4 hr, or more frequently if signs of infection are found.

Insert urinary catheter and closely monitor I & O.

Monitor IV site hourly; report to physician if bleeding and/or purulent discharge is present.

Initiate neutropenic precautions.

Neutrophils at 2000/mm3

Neutrophils at 1,650/mm3

Neutrophils at 800/mm3

Neutrophils at 1,200/mm3

Neutrophils at 450/mm3

Neutrophils at 286/mm3

Assess vital signs and skin for pallor and diaphoresis every 4 hours.

Assess all body systems, including the gums and nasal membranes, for bleeding every shift.

Assess pain hourly, specifically asking about abdominal and head pain.

Instruct the patient to vomit, urinate, and defecate into provided receptacles, and to call nursing personnel when these things occur.

Assess saline locked IVs once a shift and running IVs every 4 hours.

Apply pressure to injection sites for 1 minute.

"The patient is scheduled for a bone marrow aspiration at 1300 today."

"The patient has been spiking fevers, so we've been taking vitals every 2 hours and assessing him for signs of infection during his hourly safety checks. "

"The patient is on both neutropenic and radiation precautions. His mom is currently in the room wearing PPE, but his dad can't visit because he has a cold."

"We've given him some Miralax because his mom reports that he's straining while pooping."

Electrolytes

Uric acid

Urea nitrogen

Creatinine.

Hemoglobin

Hematocrit